Fast Five Quiz: Rheumatoid Arthritis Management

Herbert S. Diamond, MD; Abhishek Nandan, MD


February 22, 2023

Patients with RA of the cervical spine who have refractory pain, neurologic compromise, or intrinsic spinal cord signal changes on MRI are typically candidates for surgical treatment. In these patients, degeneration of the transverse ligament may lead to instability at the level of C1-C2 (atlantoaxial joint), potentially leading to cervical spinal injury, either spontaneously or due to minor trauma.

About four out of five patients with RA have significant foot involvement; however, surgery is not the first-line treatment for these patients. Before surgery is considered, podiatric issues may be addressed with the use of appropriate footwear such as a deep, wide, soft leather shoe; a metatarsal pad or bar with a rocker-bottom sole; or custom inserts. In addition, it is important to control the underlying disease activity from RA prior to pursuing surgery.

Cold therapy, which may decrease pain, is preferred to heat therapy for acutely inflamed joints. In general, heat therapy may help with pain and stiffness due to noninflammatory myalgias and arthralgia.

Physical therapy has been shown to improve function and quality of life among patients with RA. Interventions may include both aerobic conditioning and resistance exercises.

Learn more about nonpharmacologic therapies for patients with RA.

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